On 18 March, the Centers for Medicare & Medicaid Services (CMS) recommended “limiting non-essential care and expanding surge capacity into ambulatory surgical centres and other areas” to conserve resources and staff for managing COVID-19 patients. However, in a statement issued on 19 April, it now said recognises “at this time, many areas [in the USA] have a low, or relatively low and stable incidence of COVID-19, and that it is important to be flexible and allow facilities to provide care for patients needing non-emergent, non-COVID-19 healthcare”.

The CMS adds that, as states and localities begin to stabilise, “it is important to restart care that is currently being postponed, such as certain procedural care (surgeries and procedures), chronic disease care, and, ultimately, preventive care”. The CMS advises, therefore, that if states or regions have passed the Gating Criteria, they may proceed to Phase I and directs them to the new US Government’s “opening up American again” guidelines.

According to the CMS, “maximum use” of telehealth modalities is “strongly encouraged”. However, for care that cannot be accomplished virtually, the CMS has issued recommendations (the first in a series) to guide “healthcare systems and facilities as they consider resuming in-person care of non-COVID-19 patients in regions with low incidence of COVID-19 disease”.

It says that non-COVID-19 care should be offered to patients “as clinically appropriate and within a state, locality, or facility that has the resources to provide such care and the ability to quickly respond to a surge in COVID-19 cases, if necessary”. The CMS also notes that decisions should “be consistent with public health information and in collaboration with state public health authorities”.

The recommendations review, among others, general considerations, personal protective equipment, workforce availability, facility considerations, and testing capacity. They include creating non-COVID Care (NCC) zones that “would screen all patients [and staff] for symptoms of COVID-19, including temperature checks”. Another recommendation is that such NCC zones should have “have in place steps to reduce risk of COVID-19 exposure and transmission; these areas should be separate from other facilities to the degrees possible (i.e., separate building, or designated rooms or floor with a separate entrance and minimal crossover with COVID-19 areas).”